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“The Treatment Trap”

What is too much medicine and why is it bad?

I’ve talked about it before: Health care costs are crazy high; the cost of insurance is increasing to meet those costs; and more patients than ever are being harmed by the treatment that is supposed to help them.

The overuse of medical care is directly responsible, and increased patient (consumer) awareness is needed to help turn this trend around.

Although it was published in 2010, the book is still relevant. Health care reform has done little to control costs and eliminate the perverse incentives (the more doctors do, the more they get paid) that encourage overuse.

The authors define overuse as “providing a treatment when its risk of harm exceeds its potential benefit.”

Commonly overused treatments and procedures include antibiotics, x-rays, CT scans, heart bypass, back surgery, knee and hip replacement, prostate removal, hysterectomy, angioplasty, and ear tubes in children, to name just a few.

These extra, unnecessary tests add up, both in cost and consequence. They can “trigger an avalanche of more tests and treatments” causing needless pain, infection, and other complications (including death and/or huge medical bills).

How did we get here?

The authors do an excellent job explaining how our current health care culture of “more is better” evolved.

We trust our doctors. We have a deeply rooted belief that modern medicine and technology can cure all ills, even aging.

But the reality is that health care is a business, a move-more-product, generate-more-profit, keep-the-shareholders-happy business.

Have you seen or read an advertisement for a prescription drug lately? Or received a flyer from a local hospital advertising its latest high-tech procedure, such as da Vinci robotic surgery, or 3D mammography, or proton beam therapy?

It’s all about selling something.

And a hospital’s unwillingness to embrace price transparency or full disclosure of patient safety statistics helps them in this goal.

Increased health care costs and patient harm are serious problems; equally bad and perhaps longer lasting is the loss of trust we have for our doctors.

Once the general public starts to believe that we could be using patients for purposes other than their own best interest—purposes such as increasing our volume to make money or to please hospital administrators; recommending treatments without a clear and honest explanation of the risks and the alternatives—we will lose the basis of our position and power to help.

The authors acknowledge that most physicians in our country are honorable and continue to try to do the best for patients despite an increasingly difficult and bureaucratic practice environment—but the warning signs of erosion of trust of our patients are increasingly visible.

In the book, the authors quote another doctor saying, “There are three kinds of physicians—those who are in it for the money, those who do it for the right reasons, and those who are watching to see who wins.”

How are we supposed to know who is who?

What can we do?

The last chapter of the book offers twenty suggestions to protect yourself and your family from medical overuse. Here are a few:

Realize that health care is a money making business. “Many altruistic people go to work everyday to provide the best care they can. But many organizations where they work are motivated by one aim: maximize revenue. You, the patient, are the source of that revenue.”

Don’t be a cash cow. “If you have comprehensive health insurance, you could be at greater risk for needless medical treatment because you have the means to pay for it. … be aware that some providers of medical care may see your health insurance card as a credit card they can use to benefit their bottom line.”

Be media savvy. “Know how to distinguish marketing glitz from accurate information that might benefit you and your family.” They recommended the website HealthNewsReview.org, and I agree. Gary Schwitzer does a great job evaluating health care stories in the news.

Really talk to your doctor. “Your physician should explain the procedure, treatment options (including those that he or she does not perform), the evidence about what works and what doesn’t, and their risks and benefits.” Don’t trust blindly.

Know your treatment options.“The Foundation for Informed Medical Decision Making is one of the best sources of information about treatment options and their risks and benefits. … it has no bias or vested interest other than helping people make a decision they believe is right for them.”

For the entire list, pick up a copy of the book. It’s well worth reading.